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Tuesday, March 31, 2015

From Doctors to Salesman

I am not surprised to find one in five houseman quit
each year. This is actually a very high attrition rate. It represents a sheer
wastage of resources.

In 2006, when I was the Minister of Health, I
predicted that by 2014 that there would be a surplus of doctors (houseman). Malaysia with a
population of 29 million has currently a whopping 33 Medical Schools (11 public
and 22 private). In 2009, number of Medical Graduates per 100,000 populations
was 11.2 and in the year 2012, it was 14.6 (4,067 graduates).

The United Kingdom, with
a population of 63 million, has 32 Medical Schools. Australia, with a
population of 23 million, has 18 Medical Schools and Canada with a population
of 34 million has 17 Medical Schools.

We cannot deny that we
are producing more doctors than the developed countries. We are compromising
quality in order to get the quantity we think we need. With this rate, we
expect Malaysia (local and overseas) will be producing a total of about 6,000
graduates per year.

To compound the problem,
we recognize more than 350 Medical Universities worldwide. Some of these
universities have passed their prime of life.

In 2007, when it became
obvious that the quality of doctors (trained locally and overseas) was going
downhill, I decided the compulsory houseman-ship to be extended from one year
to two years. I was condemned and criticized. Some parents even wrote to me
that the two years of houseman-ship will delay them from recouping their
investment in their children medical education. Till today, I still think that
I have made a right decision to extend the houseman-ship training to 2 years. I
am confident that many senior doctors will agree with me.

Two years of compulsory
houseman-ship may help to improve their clinical knowledge but it will never be able to
rectify their shortcoming in training in the medical schools. Today, Malaysia
public hospitals are confronted with too many housemen in one ward. Sometimes, housemen
are more than the patients. This is really a Boleh-land.

Due to poor supervision
and inadequate training, a lot of housemen clerk only 1 – 3 patients per day
when they should clerk more than 10 per day in order to get adequate exposure
or training.

In short, we are
producing half-baked doctors. Some senior medical consultants told me that they
are training the un-trainable due to a host of factors: poor attitude, lacking
interest with no passion, poor basic medical training, poor command of English,
poor patient relationship skill, frustration because working condition and pay
do not meet expectation and etc.

Hence, there is a need to
relook into a more holistic solution for medical education, houseman-ship
training and expansion of public hospitals especially in semi urban areas.

If we delay we will soon
have unemployed doctors and inadequately trained medical officers.

Presently, MOH has 132
hospitals and the total number of hospital beds in the public sector is 38,394.
Currently we are short of 15,000 public hospital beds.

Those walking in the
corridor of power in Putrajaya should have the political will and commitment to
address these problems. One should not be afraid to rock the boat.

With nearly 6,000 housemen
every year, soon housemen will need to wait for more than a year to get a posting.

Ideally, the time has
come to set up a Medical Commission to address many issues confronting
medical education, training and services.

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